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SPM- Dermatology > Non-Melanoma Skin Cancers > Flashcards

Non-Melanoma Skin Cancers Flashcards

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Dermatology Board Prep flashcards
1
Q

What are actinic keratoses?

A

Also called solar keratoses

They are scaly rough patches on a red background that produce keratin creating a rough scaly surface

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2
Q

Where are actinic keratoses commonly found?

A

On sun-exposed sights such back of ears, bald scalp, shoulders, back of hands

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3
Q

Describe the features of actinic keratoses

A

Scaly rough patches
Red background
Feel like sand-paper as over produce keratin
Can be very thick or wart like

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4
Q

What actinic keratoses develop into?

A

Squamous cell carcinomas

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5
Q

What causes actinic keratoses?

A

Prolonged sun exposure- they’re common in older people with light skin

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6
Q

What should be done if actinic keratoses develop into a lump, become tender or start to bleed?

A

Medical advice should be sought, changes such as these can be a sign of squamous cell carcinoma

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7
Q

What is the treatment for actinic keratoses?

A

Protect from further sun damage- hats, sun cream etc.
Cryotherapy- Liquid nitrogen freezes the warty area and it falls off
Creams e.g 5-FU, Imiquimod (stimulates immune response) which kill the cells locally, causes inflammation at application site
Surgical removal- curettage + cautery or excision (send to pathology for assessment
Photodynamic therapy- special cream applied and the light is shone on the area
Laser treatment

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8
Q

What is Bowen’s disease?

A

Squamous cell carcinoma in-situ, it is a pre-cancerous lesion that has not yet crossed the basement membrane

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9
Q

What are the features of Bowen’s Disease?

A

Irregular scaly plaques that may be up to several cm in diameter
May be red or pigmented
Found at sun-exposed sites most commonly e.g scalp, back of ears, back of hands, lower legs (in older women)

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10
Q

How is Bowen’s disease diagnosed?

A

It can look similar to psoriasis (as it is plaque like) and so biopsy is often carried out

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11
Q

Describe the appearance of Bowen’s Disease?

A

Fixed non itchy erythematous patches of skin
Often there are multiple
Slightly scaly (different to slivery scales seen in psoriasis)

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12
Q

What is the management for Bowen’s Disease?

A 
A biopsy should be taken for assessment. 
Cryotherapy
Surgical removal- Curettage/Excision
5-FU Cream (chemotherapy agent)
Imiquimod Cream (Induces inflammation)
Photodynamic therapy
Radiotherapy and Laser

Or observation as only a small percentage develop into SCC. Advise regular self checks for other areas too.

Also advise better care in the sun- high factor creams, sun hats, avoid sun between 11 and 3 when it is most intense.

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13
Q

What is the most common form of skin cancer?

A

Basal cell carcinoma

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14
Q

What is basal cell carcinoma?

A

A slow growing, locally invasive malignant tumour of the epidermal keratinocytes, normally in older adults

Very rarely metastasises but can be locally destructive

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15
Q

What are some risk factors for the development of BCC?

A

Sun exposure- esp. intermittent high intensity sun exposure
Skin type I (always burns never tans)
Increasing age
Immunosuppression (this increases the risk of any malignancies but especially skin malignancies)
Previous history of skin cancer
Genetic predisposition/Family history

Note basal cell carcinoma can and does sometimes develop in areas not exposed to the sun.

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16
Q

What are the different morphological types of basal cell carcinoma?

A 
Nodular
Superficial
Morphoeic
Keratotic
Pigmented
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17
Q

Describe the features of nodular basal cell carcinoma

A 
Small, skin coloured nodule or papule
Pearly rolled edge
Surface telangiectasia
Necrotic or ulcerated centre
Often seen on the face
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18
Q

What should be done for BCC?

A

Stretch the overlying skin, this reveals the edge as the tumour does not produce keratin and so edges are visible.

19
Q

Describe the features of superficial basal cell carcinoma

A

Most common type on the upper trunk and shoulders
Slightly scaly irregular plaque
Think translucent rolled border
More common in younger patients

20
Q

What are the features of morphoeic BCC?

A 
This is the scarring type
Waxy, scar like plaque
Indistinct borders
Wide and deep subclinical extension
May infiltrate cutaneous nerves for peri-neural spread
21
Q

What are some high-risk features for BCC?

A

Tumours occurring on eyes, nose and lips (locally invasive and little skin for large excisions)
Tumours> 2 cm diameter
Ill defined tumours (sub-clinical invasion)
Immunosuppressed patients
Basisquamous tumours
Perinerual invasion

22
Q

What is basosquamous carcinoma?

A

Mix of BCC and SCC

Have an infiltrative growth pattern and are potentially more aggressive than other forms of BCC

23
Q

How is BCC diagnosed?

A

Clinical evaluation and confirmed with histology- often from excision biopsy

Note- some superficial types of BCC on the trunk and limbs are diagnosed clinically and have none surgical treatment without biopsy

24
Q

What is the surgical management options for BCC?

A

Surgical excision- tumour sent for histological analysis, should include 3-5mm excision margin. Flaps or grafts may be needed, may need to involve plastics.

Mohs Micrographilcally controlled excision- carefully excised and tissue is examined under the microscope, continued until tumour free. Useful for high risk areas (around face, eyes, lips and nose) and infiltrative tumours

Superficial skin surgery- curettage and cautery for small nodular tumours.

25
Q

What non-surgical options may be used to treat BCC?

A

Cryotherapy- only for small nodular tumours
5-FU Creams
Imiquimod cream
Radiotherapy- if surgery is not appropriate, suitable for frail and elderly but can lead to recurrence in young patients
Photodynamic therapy

These are only used for small and low risk lesions. Topical therapy is only suitable for superficial disease.

26
Q

What is squamous cell carcinoma?

A

The second most common type of skin cancer after BCC. Same risk factors as for other skin malignancies.

SCC is a locally invasive malignant tumour of the epidermal keratinocytes or its appendages, has the potential to metastasise. Metastasis is uncommon.

27
Q

Describe the features of SCC?

A

Tend to be warty tumours
Initially they produce keratin which gives a scaly surface
Poorly differentiated tumours loose the ability to produce keratin and this causes ulcerated nodules

28
Q

Describe the features of SCC?

A

One or more irregular scaly plaque up to several cm in diameter
Red or pigmented
Ulcerated if poorly differentiated
Common on sun exposed sites- ears, scalp, back of hands, lower legs

Note-psoriasis may appear similar but this has a symmetrical distribution.

29
Q

What is keratocanthoma?

A

SCC variant that undergoes spontaneous resolution

There is very rapid growth, hard keratin plug forms. It resolves to leave a depressed scar. Occurs in sun-exposed areas like SCC.

30
Q

How is keratocanthoma managed?

A

It is difficult to distinguish from SCC and so is managed in the same way

31
Q

What virus has keratocanthoma be found to be associated with?

A

HPV

32
Q

What is a cutaneous horn?

A

SCC hyper-produces keratin which can lead to the formation of a hard keratin horn. This occurs with well differentiated SCC

33
Q

What is seen with poorly differentiated SCC?

A

Less keratin production and less scaly surface instead they are more likely for form a nodule with ulceration

34
Q

If a patient with SCC reports a high degree of pain what alarm bells might this ring?

A

SCC can invade along the peri-neural route

This can cause considerable pain and can indicate a more invasive tumour.

35
Q

What is the surgical management for SCC?

A

Surgical excision with margins of 3-5mm- send for pathological analysis.

Curettage and cautery should be avoided due to risks of deep invasion

Mohs Micrographilcally Controlled Excision if clear margins likely to be difficult to achieve

36
Q

What non-surgical options may be used for the treatment of SCC?

A

Only considered in low risk cases- clear no local invasion, no adverse signs, small, superficial

Cryotherapy

Radiotherapy- at sites where surgery not suitable, frail, elderly or palliative patients

5-FU, Imiquimod Cream

37
Q

What advice should be given for all patients with skin cancers after treatment?

A

Better sun-care
Use high factor suncreams
Wear sun hats
Avoid intense sunlight exposure

38
Q

What is the follow up for SCC?

A

Check the scar
Monitor for recurrence and local spread
Low tumours followed up at 3 months and discharged if no signs of recurrence
High risk tumours followed for 2 years at 3 monthly intervals
Patients on immunosuppression followed up for 5 years

39
Q

What is mycosis fungoides?

A

A rare T-cell lymphoma of the skin, or cutaneous T cell lymphoma

40
Q

How does mycosis fungoides appear?

A

A rash that usually develops slowly over many years
Irregularly shaped dry patches (patch stage)
Occurs in areas of the skin that are usually protected from the skin (looks similar to eczema and psoriasis)
Patches thicken to form plaques (plaque stage)
Skin can redden all over- developing into erythroderma
Later lumps can develop- called he tumour stage

41
Q

How is mycosis fungoides diagnosed?

A

A skin biopsy is used to confirm the diagnosis

42
Q

What is mycosis fungoides misdiagnosed as?

A

Eczema or psoriasis

43
Q

How is mycosis fungoides managed?

A

Staged according to degree of skin and lymph node and haematological involvement
Early disease is managed with moisturisers, topical steroids and phototherapy
More extensive or advanced disease may need radiotherapy or chemotherapy
Methotrexate- slows down the production of new cells

Vast majority do not die from the disease

44
Q

Does mycosis fungoides cause may symptoms?

A

The most common symptoms are itching and rarely pain in the affected areas

SPM- Dermatology (10 decks)

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